RSS 1.0South Infirmary Victoria University Hospital
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Research by staff affiliated to South Infirmary-Victoria University Hospital
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Increasing melanoma awareness among health and social care professionals in secondary care in an era of reduced skin cancer referrals due to COVID-19.The role of secondary care providers in detecting melanoma has been poorly explored. Our recent study identified that patients with thick melanomas were seen in secondary care in the year prior to their melanoma diagnosis. In this era of reduced skin cancer referrals and heightened public anxiety, it is more important than ever that health professionals are equipped with the knowledge to identify atypical skin lesions to facilitate earlier detection and treatment. The aim of this study was to evaluate the level of awareness of skin cancer among health and social care professionals in secondary care and to facilitate education sessions on skin cancer awareness.
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Bare necessities? The utility of full skin examination in the COVID-19 era.Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low-risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion-directed examination is low.
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Distance as a Barrier to Melanoma CareOur aim was to review cases of melanoma diagnosed histologically in UHK in 2016 and to compare them to cases of melanoma nationally and in Kerry. Methods For each patient we recorded age, Breslow depth, and shortest distance to travel by car and travelling time (without traffic) to the South Infirmary Victoria University Hospital (SIVUH) from their primary residence (calculated using Google maps™ (2018)). Results 20 cases of invasive melanoma were diagnosed in UHK in 2016. Of the 20 cases, 9 (45%) presented at a very advanced stage with a Breslow depth of greater than 4mm. A further 7 (35%) cases had a depth of 1.5-4mm. These patients with invasive melanoma had a mean age of 72.5 (±15). The mean shortest distance to travel from the patient’s primary residence to the SIVUH was 114.8km (±15.5) taking an average of 102 minutes (±14.6) by car. Conclusion Cases of melanoma diagnosed locally in UHK presented at an advanced stage compared to the national average. We suspect that the long distances to travel to the SIVUH pigmented lesion clinic is a barrier for these patients.
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Skin Cancer Awareness Amongst Irish GolfersThe aim of this study was to assess skin cancer awareness and identify the UV protective measures used by golfers within the Munster region of Ireland.
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Critical Airway Compromise due to a Massive Vagal SchwannomaWe describe the case of a 37-year-old man with a slowly enlarging neck lump and compressive symptoms. He presented to a separate institution 10 years prior where an observational approach was advocated. Following preoperative investigations and embolization, an 11cm vagal schwannoma was excised and vagus nerve was sacrificed. Although conservative management is appropriate for a select patient population, surgical excision is treatment of choice for cervical neurogenic tumours and paraganglionomas and must be considered in young patients or rapidly expanding tumours to avoid compressive symptoms, as in this case.
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Changing paradigms for oropharynx cancer: swinging of pendulum back towards surgeryThe oropharynx, extending from the soft palate to the level of the epiglottis, and containing the palatine tonsils and base of tongue (BOT), is a common site for Head and Neck cancer. Squamous cell carcinoma (SCC) comprises the overwhelming majority of cases. Traditional aetiological factors for oropharynx SCC (OPSCC) are smoking and alcohol consumption. In recent years, human papilloma virus (HPV) type 16 has emerged as the major cause of an ever increasing number of cases 1 . Over the last two decades, there has been a dramatic surge in the incidence of OPSCC. Figures obtained by the Irish National Cancer Registry show an increase from 50 cases per year in 1994 to over 100 cases per year in 2012. This recent rise in OPSCC incidence is almost exclusively related to an increase in HPV related cancers. In the United States, between 1988 and 2004, HPV related OPSCC showed a 225% increase, while HPV-negative OP SCC showed a 50% decline, attributed to decreased prevalence of smoking 1 .
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The prevalence and genotype of human papillomavirus on cervical samples from an Irish female population with external genital warts.The aim of this study was to determine the cervical genotype profile of females who presented to an STI Clinic with external genital warts (EGW); and to determine the potential vaccine coverage prior to the uptake of the HPV vaccines. Sixty-one cervical scrapings were taken from females aged 18-35 y who had external genital warts or a history of external genital warts. The resulting 50 samples that were positive for HPV-DNA were subjected to genotype identification. Forty-six of these samples had detectable genotypes by LIPA analysis and most (78%, 36/46) had multiple low risk (LR) and high risk (HR) genotypes on the cervix. Twenty-five of these samples (54%) had more than 1 HR genotype. Of the 36 patients who had any HR genotypes, 18 (50%) were identified to have the most oncogenic HPV genotypes, namely 16 and 18. Three of these samples had both 16 and 18 on the cervix. The presence of multiple HR genotypes on the majority of cervical samples from a self-referred population of females with EGW is presented. This study is of importance since persistent HR-HPV is the necessary risk factor in the development of precancerous and cancerous lesions of the cervix. Gardisil, the quadrivalent HPV vaccine would have been useful in the prevention of 28% (13/46) of these infections.
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The impact of HSV for inflammatory arthropathy patients.Herpes simplex virus type 1 (HSV-1), also known as herpes labialis, is the etiologic agent of vesicular lesions of the oral mucosa commonly referred to as "cold sores". HSV-1 can also cause clinical disease in a wide variety of other anatomic locations including the genitalia, liver, lung, eye, and central nervous system. These infections can be severe, particularly in the setting of immunosuppression, such as inflammatory arthropathy patients on Methotrexate ± biological therapies. Here, we highlight the importance of physician awareness of HSV due to its potential impact for rheumatology patients.
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A history of haemovigilance South Infirmary Victoria University Hospital 2000 - PresentThe Haemovigilance speciality defines itself as nursing and subscribes to the overall purpose, functions and ethical standards of nursing. The clinical practice role may be divided into direct and indirect care. Direct care comprises the assessment, planning, delivery and evaluation of care to patients. Indirect care relates to activities that influence others in their provision of direct care. The Haemovigilance Officer as a clinical professional in the Irish healthcare environment is required to maintain professional competency and this is achieved through continuous ongoing education and training, attending in-service study days, conferences locally and nationally. While attending various conferences numerous posters have been presented which have showcased the hospital’s work. Evidence of continuous professional development is contained in Appendix 1. Mission Statement: In collaboration with nursing staff, medical staff and the Irish Blood Transfusion Service, the Haemovigilance Officer strives to deliver an effective, efficient, cost effective and quality transfusion service for the patients of the SIVUH through ongoing education, surveillance and clinical audit. (Reviewed August 2011). Haemovigilance is internationally recognised as essential to the development of safe clinical transfusion practice. As the time of writing this report, the hospital in the context of the Reconfiguration of Health services for the Cork and Kerry region, is in a transitional phase as the hospital moves from an acute general hospital to an elective and largely surgical hospital. Such changes in the nature and type of clinical service provision will naturally impact on the requirement for blood and blood products.
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Eccrine porocarcinoma arising within an area of Bowen disease.Summary Very little is known about the aetiology of eccrine porocarcinoma (EP), a rare malignant sweat-gland tumour. Most reported cases have arisen de novo, or from a benign eccrine poroma. We report an unusual case, in which eccrine porocarcinoma arose at the exact site of pre-existing Bowen disease (BD).
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Koebner phenomenon of the ear canal skin.The Koebner phenomenon originally described the appearance of psoriatic lesions in the uninvolved skin of patients with psoriasis as a consequence of trauma. We describe a case of concurrent lichen planus and sarcoidosis in the auditory canal, which represents an unusual manifestation of the Koebner phenomenon. This is the first case of concurrent lichen planus and sarcoidosis in the head and neck region and highlights the need for biopsy to allow accurate histopathological diagnosis and treatment.
